About the service: Cymar House is a care home which was providing personal care to 24 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

• Systems and processes were in place to keep people safe and staff understood procedures to follow to ensure people were safeguarded from abuse.

• Medicines were managed safely, although some guidance for staff was not clear, such as when people may be in need of pain relief or were feeling agitated.

• Staff recruitment procedures were in place and the numbers of staff on duty met people’s needs.

• Staff training was completed in many areas, and the service had a designated trainer

• We received mixed feedback about the quality of the food. The service advertised ‘home cooked food’. However, this was no longer prepared in the home, but brought in from an external source.

• There were kind and caring interactions between staff, people and families, and staff showed respect for people’s privacy and dignity.

• Care records contained relevant information although some had incomplete and conflicting detail.

• Activities took place, although there was not much happening to keep people occupied during the inspection.

• The management team was visible in the service and staff understood their roles and responsibilities. There was effective teamwork and staff felt supported.

• Systems and processes were in place to monitor the quality of the service and the registered manager responded promptly to address areas identified through the inspection.

Rating at last inspection: Good (report published 19 August 2016)

Why we inspected: This was a planned inspection based on the previous rating

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 14 July 2016 and was unannounced. This meant the registered provider did not know we would be visiting.

The service was registered with the Care Quality Commission on 20 May 2011. They were last inspected on 8 April 2014 and were found to be compliant.

Cymar House accommodates up to 25 older people, the majority having either dementia or mental health problems. The service does not accommodate people who have nursing needs. The service is owned by Warmest Welcome Ltd and is located in Glasshoughton in Castleford.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Systems were in place to ensure that the medicines had been ordered, stored, administered, disposed of and audited appropriately. Staff we spoke with knew how to administer medicines safely and the records we saw showed that medicines were being administered correctly. However there were some discrepancies with the stock counts of medicines we looked at.

People and their relatives told us they felt that care was delivered safely. Individual risk assessments were being undertaken and key risks specific to the person such as choking and falls were being identified but no record subsequently highlighted what action should be taken to mitigate these risks.

The service had an up to date safeguarding policy in place and staff had a working knowledge of this. They were able to tell us about different types of abuse and were aware of the action they should take if they suspected abuse was taking place. Staff were also aware of whistle blowing procedures.

Accidents and incidents were appropriately recorded and analysed so that any trends could be identified.

We saw that safe recruitment and selection procedures were in place and appropriate checks had been undertaken prior to staff starting work. The checks included obtaining references from previous employers and a Disclosure and Barring Service check to ensure that staff were safe to work with vulnerable people.

We saw that at most times there were sufficient numbers of staff on duty in order to meet the needs of people who used the service. However staff did find it more difficult to manage during mealtimes and this led to people being taken to the dining room approximately half an hour before their lunch was served.

Appropriate maintenance checks had been regularly undertaken to ensure that the environment was safe however water temperatures had not been within safe limits. This was immediately addressed after we pointed it out. We saw up to date certificates for safety standards such as gas safety, fire equipment and portable appliance testing.

Staff received appropriate training and had the skills and knowledge to provide support to the people they cared for and this included specialist training specific to the needs of the people using this service. New staff underwent comprehensive induction training and mandatory training was refreshed regularly in line with the training policy.

Staff had a working knowledge of the principles of consent and the Mental Capacity Act. We saw evidence of capacity assessments being undertaken and best interest decisions being made. Although there had been some initial confusion around the application for Deprivation of Liberty Safeguards (DoLS) authorisations we saw that the service was now following the appropriate procedure.

Staff received regular supervision and annual appraisals to monitor their performance and felt that these sessions provided a useful forum for discussion.

People were supported to access external health services such as dentists and opticians to ensure their general health and wellbeing. Peopl

The inspection helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The provider acted in accordance with legal requirements where people did not have the capacity to consent. Staff had an awareness of the Mental Capacity Act and deprivation of liberty safeguards. Staff understood their obligations with respect to people's rights and choices when they appeared to lack mental capacity to make informed and appropriate decisions. The manager told us most of the staff had received training around the Mental Capacity Act in 2013.

Each person's care file had risk assessments which covered areas of potential risk such as pressure ulcers, falls and nutrition. When people were identified as being at risk, their plans showed the actions required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

Staff demonstrated good knowledge and awareness of their responsibilities for infection prevention and control and there was evidence staff had received relevant training. Two members of staff we spoke with during the inspection confirmed they had completed infection control training.

Staffing levels were assessed depending on people's need and occupancy levels. The staffing levels were then adjusted accordingly. They said where there was a shortfall, for example when staff were off sick or on leave, existing staff worked additional hours to make sure there was continuity in service

We spoke with four visitors and they told us they were pleased with the care, treatment and support their relative’s received at Cymar House. They said the staff were quick to inform them of any significant changes in their relative’s general health and they were always made to feel very welcome when they visited. One person said, “I cannot fault the service provided; people are well looked after.”

Is the service effective?

The home had a good working relationship with other healthcare professionals and always followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded in their care plan.

People’s files contained pre-admission assessments, which showed that people's health, personal and social care needs were assessed before they moved into the home.

Is the service caring?

Visitors we spoke with told us they were very happy with the care provided and in their opinion people were well looked after. They described staff as friendly, patient and caring.

People who used the service told us they were happy with the staff at Cymar House and with the care they provided. One person said, “The staff are very good, lovely people." Another person told us, “Excellent people.”

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

The provider’s quality assurance feedback from people who used the service, relatives and visitors, showed there was a high level of satisfaction. All felt the quality of care was excellent or good. The registered provider had analysed the results and identified what they could improve and develop.

Is the service responsive?

People and their families were involved in discussions about their care and the risk factors associated with this. Individual choices and decisions were documented in the care plans and reviewed on a regular basis.

We saw the complaints log and saw any complaints made had been acted upon appropriately and any actions taken had been fed back to the person making the complaint.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

You can see our judgements on the front page of this report.

The CQC had received concerns regarding this service; therefore we brought forward the annual inspection. When we carried out the inspection we found the service to be compliant. We spoke with three people who used the service, a visitor, seven members of staff, the manager and Care Director. We reviewed four staff files and four care records.

We observed that people who used the service could choose when they wanted to get up; we also saw evidence of this reflected in people’s care records. People looked well cared for and were seen to have good relationships with the staff. People who used the service told us they were happy living at the home and they were well looked after. We observed people were treated with respect and dignity.

Care records were up to date and reviewed monthly with risk assessments used to develop guidelines for staff to follow to reduce an identified risk. There were safeguarding and whistleblowing policies in place to provide staff with guidance about protecting people from abuse.

Training records confirmed that all staff had completed training in safeguarding and statutory training. We saw evidence of annual appraisals and regular supervision between staff and the manager or Care Director.

We reviewed the summary results from feedback questionnaires completed by people who used the service and their relatives in July 2012. The feedback was positive.

Because the majority of people who were living in the home had some form of dementia, we had difficulty in being able to communicate effectively with them. However, we were able to speak with one person living there.

The person told us they were encouraged to maintain their independence.

They said there were now more choices of food at mealtimes.

They told us “This is a great place to live. Staff take me out, everyone is so genuine and we all get on. The atmosphere here is lovely and calm and we have a good laugh between each other and with staff.”

The person said they had no concerns and were encouraged to have their say in how the home was run.

We carried out this inspection visit earlier than planned after receiving information alleging that staff did not inform the person’s GP when they were unwell, there was a lack of activities and choice of foods at mealtimes, moving and handling practices were poor and management arrangements were inadequate.

Because the majority of people who were living in the home had some form of dementia, we had difficulty in being able to communicate effectively with them. However, we were able to speak to one person living there, two relatives and a friend of one person who was at the home.

A person who was living in the home told us they were encouraged to make their own decisions but needed support to do this. They said staff were kind and helpful but always seemed busy. However, they did say staff were always available if they needed any kind of support.

Relatives said they did not know about care plans and had not had any involvement in developing these or in any subsequent reviews and discussion about their relative’s care. People had little understanding how care was planned, monitored and recorded.

Relatives told us they could visit at any time. Another commented that their relative had regular baths and liked the food provided. They also told us staff always kept them informed about any incidents.”

Relatives said they were given information about the home including how to raise any concerns and details about what to do if they wish to make a complaint.